In July 2010, a focus group meeting on Creatine in Health, Medicine and Sport was held in the New Howard Theatre, Downing College, University of Cambridge. The last such meeting was held just over 10 years ago at which time the main topic of discussion was the increasing use of creatine (Cr) supplements in sport. While still extensively used by athletes, Cr supplementation (Hultman et al. 1996) is today being examined for its health and medical benefits. The purpose of the Downing College meeting was to bring together leading biochemists and physiologists with those involved with Cr applications in health, medicine and sport, and to exchange experience and knowledge in this emerging field. Theoretical considerations were given equal weightage to applied applications since an understanding of the basic biochemistry and physiology inevitably will underpin any nutritional, health and medical benefits. Sadly, the teaching of the creatine-phosphorylcreatine-creatine kinase (Cr/PCr/CK) system, particularly in the field of sports sciences, is often so simplified these days as to obscure mechanisms supporting, as well as failing, cell functions. From a total of 16 review and 9 research presentations at the Downing College meeting, 12 of the reviews are included in this special issue of Amino Acids. Creatine is a member of the guanidino phosphagen family, which is unique to eukaryotic cells. Altogether, there are eight related forms, of which seven are considered to be chemically derived from arginine, with arginine itself making up the eighth. As with the others, Cr may bond a phosphoryl group to form PCr, through the action of CK. The Cr/PCr/CK system has its counterparts in the remaining seven other phosphagens, for instance for arginine (A) there is a phosphorylated arginine (PA) formed through the action of arginine kinase (AK). Since A/PA/ AK is confined to invertebrates and Cr/PCr/CK is the only form found in vertebrates, it was at one time thought that CK evolved after AK, although today, it is known that both are equally ancient. The classical role of PCr is seen as a reservoir of highenergy phosphates defending cellular ATP levels under anaerobic conditions, high rates of energy transfer or rapid fluctuations in energy requirement. Although the high concentration of PCr in glycolytic fast-twitch fibers supports the role of PCr as a buffer of ATP, the primary importance of the CK reaction may in fact be to counteract large increases in ADP, which could otherwise inhibit cellular ATPase mediated systems (Sahlin and Harris 2011). Progressive failure in muscle of the Cr/PCr/CK system to maintain ADP homeostasis may point to a common mechanism of fatigue with glycogen depletion and declining pHi, as well as the onset of adenine nucleotide degradation first shown in human muscle by Hultman et al. (1967). From examination of the dynamics and distribution of CK, it is evident that the Cr/PCr/CK system contributes to cellular metabolism in at least three fundamental ways; as (1) an immediately available temporal energy buffer at sites of rapid ATP turnover, (2) a spatial energy buffer or intracellular energy transport system (i.e., the CK/PCr energy shuttle or circuit), and (3) as a metabolic regulator of oxidative phosphorylation (Guzun et al. 2011; Wallimann et al. 2011). As a temporal buffer, Cr/PCr/CK both regenerates ATP and maintains ADP at a low concentration. The CK/PCr energy shuttle connects sites of ATP production (glycolysis and mitochondrial oxidative phosphorylation) with subcellular sites of ATP utilization R. Harris (&) Junipa Ltd, Newmarket, UK e-mail: junipa@ymail.com
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